Surgical Treatment of Recurrent Pleomorphic Adenoma of the Parotid Gland

Niparko, John K.; Beauchamp, Mark L.; Krause, Charles J.; Baker, Shan R.; Work, Walter P.

doi:10.1001/archotol.1986.03780110056007

Cited by 81 publications

(56 citation statements)

References 20 publications

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“…When the first parotidectomies were carried out in the late 1800s, tumors were enucleated to avoid facial nerve injury. With enucleation of a tumor, however, the recurrence rate was 40% and with a full radical resection, but preserving the facial nerve, the recurrence rate was 1% (Patey and Thackray, 1958;Niparko et al, 1986). As a result of this work, the standard treatment of a pleomorphic adenoma is to resect the whole lobe containing the tumor with dissection and preservation of the facial nerve.…”

Section: Discussionmentioning

confidence: 90%

Surgical anatomy of the parotid duct with emphasis on the major tributaries forming the duct and the relationship of the facial nerve to the duct

et al. 2004

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Although there is a great amount in the literature to describe the anatomy of the parotid gland as a whole, little attention is given to the parotid duct. The purpose of this study is to examine the surgical anatomy of the parotid duct with special emphasis placed on the major tributaries forming the parotid duct and the relationship of the facial nerve to the duct. Twenty-nine fresh cadaver halves were dissected and the branching pattern of the ducts, position within the parotid, and their relationship to the facial nerve were studied. Of the complete heads studied, the parotid duct had the same pattern in 78.6% on the right and left sides. The parotid ducts in 31.0% of the half heads presented as a single discernible duct from parotid papilla to within the gland. In 62.1% of the half heads, the ducts were formed by a branching pattern within the gland. In the ducts with a branching pattern, 48.3% displayed a bifurcated pattern, 6.9% were trifurcated, and 6.9% had multiple branches. In 6.9% of the half heads studied, the parotid ducts bifurcated distal to the parotid gland. In all cases, the deep lobe of the parotid enveloped the parotid duct; only small ductules connected the superficial lobe with the duct. The facial nerve and its branches were always observed lateral to the parotid duct. Because one dissects lateral to the facial nerve during a superficial parotidectomy, generally the parotid duct remains intact and potential complications such as facial paralysis, sialoceles, and fistulizations are thereby minimized.

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Section: Discussionmentioning

confidence: 90%

Surgical anatomy of the parotid duct with emphasis on the major tributaries forming the duct and the relationship of the facial nerve to the duct

et al. 2004

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“…Recurrent mixed tumors are almost always multinodular [34,35], Imaging studies (ultrasound and MRI) coupled with clinical examination are more accurate than clinical examination alone. Historically, the chief cause for tumor recurrence was enucleation [1,33,36] due to retention of capsular components. In contemporary practice, it is the older, hypocellular tumors (myxoid-type tumors) which are more delicate and prone to rupture [20,21].…”

Section: Recurrence Risk For Bmtmentioning

confidence: 99%

The Role of Extracapsular Dissection for Benign Parotid Tumors

Witt

Iro

McGurk

2014

Curr Otorhinolaryngol Rep

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Surgical treatment of benign parotid tumors has been debated for decades. Extracapsular dissection (ECD) differs markedly from classic surgical approaches to the parotid neoplasm because facial nerve dissection is not performed. ECD, its advantages, disadvantages, indications, and contra-indications for benign tumors with an emphasis on benign mixed tumor will be comprehensively explored in this chapter. Factors noted to favor this approach include mobility of the tumor within the gland, a thin covering of capsule and glandular tissue, and a tumor large enough to allow digital manipulation during dissection. Imaging, fine needle aspiration cytology, and neuromonitoring play a heightened role in ECD. Recurrence and permanent facial nerve dysfunction with ECD are not higher in high volume centers performed by experienced surgeons. Transient facial nerve dysfunction, Frey's syndrome, sensory deficits, and sialocele are lower with ECD. Devastating adverse outcomes of permanent facial nerve dysfunction and recurrence should be considered by the occasional and inexperienced parotid surgeon.

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“…This poor prognostic indicator has been published previously. 17,18 Moreover, as life expectancy increases, patient with PPSPAs will continue to present later in life.…”

Section: Discussionmentioning

confidence: 99%